Jennifer Riley
Individual provider Active NPI Family Nurse Practitioner · Jacksboro, TN
NPI 1447875166 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1447875166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 27649 (TN)
- Practice address
- 2702 Jacksboro Pike
Jacksboro, TN 37757-4850 - Phone
- (423) 201-9937
- NPI assigned
- Jun 9, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- East Tennessee State University Quillen College of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Velocity Medical LLC
Practice addresses (Care Compare)
2702 Jacksboro Pike
Jacksboro, TN 37757-4850
Phone (423) 201-9937
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200721004209 | TN | Practitioner - Nurse Practitioner | 1052735297 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27649 | TN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians LLC | Nurse Practitioner | Current |
Accepting new patients |
| Velocity Medical LLC | Current |
Accepting new patients |
Locations
2702 Jacksboro Pike
Jacksboro, TN 37757
Phone (423) 201-9937
9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000
2018 Clinch Ave
Knoxville, TN 37916
Phone (865) 541-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 27649 | TN | |
| Family Nurse Practitioner | 363LF0000X | 27649 | TN | Yes |
Addresses
Primary practice location
2702 Jacksboro Pike
Jacksboro, TN 37757-4850
Mailing address
2702 Jacksboro Pike
Jacksboro, TN 37757-4850
Phone (423) 201-9937
Other providers in Jacksboro, TN
- John Redus
- Renovation Health and Wellness
- Stephanie Kaye Reynolds
- Riggs Drug Store
- Stacy Jean Riggs
- Geraldine Rivera Matos
- Roane Pharmacy Inc
- Thomas Wayne Robbins
- April D Rodriguez
- Linda Ross
All providers in Jacksboro, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.